Healthcare Provider Details

I. General information

NPI: 1720329022
Provider Name (Legal Business Name): EMERGING VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

IV. Provider business mailing address

8025 TYSONS CORNER CTR
MC LEAN VA
22102-4525
US

V. Phone/Fax

Practice location:
  • Phone: 703-734-0977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SHASHATI
Title or Position: PRESIDENT
Credential:
Phone: 800-454-4647